See pain duration and severity before you book the slot
Patients describe how long they've had pelvic pain, whether it limits daily activities, and any prior evaluation or testing before a slot is scheduled. Cliont scores each response and sends qualified cases, plus any uploaded test results, directly to your CRM.
The exact intake your pelvic pain evaluation leads complete
This is the real 6-question guided intake for Pelvic Pain Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified pelvic pain evaluation lead should tell you
A structured clinical intake for women reporting pelvic pain, used to capture pain duration, pattern, severity, and related symptoms so a provider can determine the right diagnostic pathway.
- Long Have Been Experiencing
- Would Describe Pattern Pain
- Pain Severe Enough Limit
- Pregnant Or Pregnancy Possible
- Had Any Prior Evaluation
- Have Any Related Symptoms
The questions your team needs answered
Every pelvic pain evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How long have you been experiencing pelvic pain? | Longer duration answers carry higher weight, reflecting that chronic unresolved pain usually needs a more thorough evaluation than a case that started this week. |
| How would you describe the pattern of your pain? | The pain pattern (constant, cyclical, unpredictable, or activity-triggered) helps staff judge whether the case fits pelvic pain evaluation or is better routed toward a menstrual-cycle-focused visit. |
| Is the pain severe enough to limit your daily activities? | A 'Yes' to activity-limiting pain is weighted more than double a 'No', making it one of the strongest single indicators of clinical priority. |
| Are you currently pregnant or is pregnancy possible? | Pregnancy status directly affects which evaluations and imaging are appropriate, so 'Not sure' answers need confirmation before a slot is booked. |
| Have you had any prior evaluation or testing for this pain? | Prior evaluation history is the most heavily weighted field, since patients already diagnosed and seeking further care typically need a different visit type than a first workup. |
| Do you have any related symptoms such as bleeding, fever, or urinary changes? | Multi-select symptoms like fever or abnormal bleeding can signal a condition needing prompt attention rather than a routine scheduling queue. |
How Cliont scores pelvic pain evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Less than a week
- 1 to 4 weeks
- 1 to 6 months
- More than 6 months
- Pain Severe Enough Limit: yes
- No prior evaluation
Urgency signals
- Pain Severe Enough Limit
See the lead your team receives
Pelvic Pain Evaluation Lead
From first click to qualified lead
Follow patients and caregivers through one smooth, guided flow.
They land & meet you
Your video greeting plays instantly — a real face instead of a blank form.
They explain the visit
Smart questions adapt to their visit and capture the full scope.
They share details
Symptoms, history, and documents come attached before the visit.
You get a ready lead
Scored and qualified — waiting for you to win it.
Built for pelvic pain evaluation workflows
| Cliont capability | Pelvic Pain Evaluation application |
|---|---|
| Multi-select symptom flagging | Answers to the related-symptoms question (bleeding, fever, urinary or digestive changes) are captured as distinct flags on the lead so staff can spot infection or red-flag combinations at a glance. |
| Weighted answer scoring | Duration, severity, and prior-evaluation answers are weighted so chronic, undiagnosed, activity-limiting cases rank above short-lived or already-managed pain. |
| CRM lead routing | Completed pelvic pain intakes, including any uploaded prior test results, arrive in your CRM with the full answer set attached rather than a bare contact request. |
| Pregnancy-status capture | The 'Yes / No / Not sure' pregnancy question is preserved as its own field so front-desk staff can confirm eligibility for the requested evaluation before finalizing a slot. |
Common pelvic pain evaluation lead scenarios
Chronic pain, never evaluated
Pain lasting more than six months with no prior evaluation and activity-limiting severity scores as a top priority, since these are the highest-weighted signals in the catalog.
New pain with pregnancy uncertainty
A patient reporting pain under a week with pregnancy status marked 'Not sure' needs staff eyes on the answer before an imaging-dependent evaluation is booked.
Diagnosed, seeking a second opinion
A patient who selects 'Diagnosed, seeking further care' for prior evaluation carries the highest weight in that field, signaling a case that likely needs a specialist rather than a first-visit intake.
Cyclical pain with red-flag symptoms
Pain tied to the menstrual cycle combined with abnormal bleeding or fever selected in the related-symptoms question flags a different urgency profile than pattern or duration alone would suggest.
Mild, activity-triggered discomfort
Pain triggered by specific activities, not limiting daily function, and with no related symptoms selected represents a lower-intensity case still worth routing for a routine evaluation slot.
Connect Cliont to your workflow
Send leads
HubSpot, HighLevel, Salesforce, JobNimbus
Book visits
Google Calendar, Outlook Calendar, Calendly
Notify your team
Email, SMS, Slack
Automate follow-up
Zapier, Webhooks, API
Simple, transparent pricing
Choose the plan that works for your business.
Professional
Unlimited intake forms and leads for your growing business.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Advanced analytics dashboard
Pay Per Lead
Only pay when you receive a qualified lead.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Charged only for submitted leads
More women's health intake templates
Pelvic Pain Evaluation lead-intake FAQs
How does the intake decide which pelvic pain leads are highest priority?
Longer pain duration, activity-limiting severity, and having had no prior evaluation are the highest-weighted answers in the catalog, so leads combining those factors surface first in your CRM.
What happens if a patient answers 'Not sure' to the pregnancy question?
That answer isn't scored on its own, but it's a clinical determinant for whether certain evaluations or imaging are appropriate, so staff can review it before confirming a booking.
Can the intake surface red-flag symptoms like fever or abnormal bleeding?
Yes, the related-symptoms question is a multi-select, so any combination of fever, abnormal bleeding, or urinary changes is visible on the lead record for staff to triage before scheduling.
Does the intake distinguish cyclical pain from constant pain?
The pain-pattern question captures whether pain is constant, cycle-linked, unpredictable, or activity-triggered, giving staff context on presentation type alongside duration and severity.
What if a patient has already been diagnosed elsewhere?
Selecting 'Diagnosed, seeking further care' carries the highest weight in the prior-evaluation question, which typically indicates a case looking for a second opinion or continued management rather than a first workup.
Does this intake replace clinical judgment about who to schedule?
No. It organizes duration, severity, prior evaluation, and symptom answers into a scored lead so staff can make the scheduling call themselves, particularly on pregnancy or red-flag combinations.
Turn pelvic pain evaluation visitors into qualified patients
Give every pelvic pain evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.